Canadian cervical spine rule

Background

Only applies to GCS=15 and stable blunt neck trauma. Not applicable for non-trauma, GCS<15, Hemodynamically unstable, Age <16, Acute paralysis, previous spinal disease or surgery.

Rule

If ANY High Risk factor present – then get an X-ray

1. Age >65 years
2. Dangerous mechanism
   1. fall from elevation ≥ 3 feet / 5 stairs
   2. axial load to head, e.g. diving
   3. MVC high speed (>100km/hr), rollover, ejection
   4. motorized recreational vehicles
   5. bicycle struck or collision
3. Parasthesia in extremities

If ANY Low-Risk factor present – then assess clinically with ROM testing

(If the answer to any of these is NO then get an x-ray)

1. Simple rear-end MVC which DOES NOT include the following
   1. pushed into oncoming traffic
   2. hit by bus / large truck
   3. rollover
   4. hit by high speed vehicle
2. Sitting in ED
3. Ambulatory at anytime
4. Delayed onset of neck pain
5. Absence midline c-spine tenderness

Able to actively rotate neck?

1. 45 Degree Left and Right? If able then NO x-ray needed. If unable, get an x-ray.

Canadian rule vs. Nexus

Sensitivity

Canadian 99.4% vs Nexus 90.7%

Specificity

Canadian 45.1% vs. Nexus 36.8%

Based on a prospective cohort trial Canadian rule "would have missed 1 patient and the [Nexus rule] would have missed 16 patients with important injuries."

See Also

• EBQ:Canadian C-spine Rule Study
• C-Spine X-Ray
• NEXUS cervical spine rule
• C-Spine (EAST)

References

• N Engl J Med 2003; 349:2510-2518
• http://www.ohri.ca/emerg/cdr/cspine.html